Men In Nursing 1. Men in Nursing: Past and Present. Kyle Ozimkiewicz. University of Pennsylvania

Transcription

1 Men In Nursing 1 Men in Nursing: Past and Present Kyle Ozimkiewicz University of Pennsylvania

2 Men In Nursing 2 Men in Nursing: Past and Present Throughout history, nursing has been seen as a female and motherly profession. Nursing required certain womanly characteristics, such as kindness and compassion, that many believed could only be exhibited by females. Early nursing leaders such as Florence Nightingale and Lavinia Dock especially promoted the idea that nursing was a feminine profession where men could not work successfully because they were seen as incapable of caring for others. Nightingale specifically campaigned for nursing to be a female profession because women were seen as more compassionate and caring. Dock, an early feminist leader, fought to establish nursing as a female profession in order to increase the independence of women in the early 20 th century. (Estabrooks, 2005) While it is true that nursing is a predominantly female profession, male nurses are often forgotten and overlooked. More so, male nurses are often stereotyped into working within certain high-technology, fast-paced areas of nursing, such as psychiatric nursing, critical care nursing, or nurse anesthesia. By assuming that all male nurses work in these specific areas and denying the possibility that men can display kindness and compassion to the ill in more intimate areas, such as floor nursing, the public is doing men in nursing a great disservice. Male nurses are viewed as not truly caring for their patients and being more interested in the technology and critical thinking aspects of nursing. While this may be true for some male nurses, for many others this view creates a problem in which the public possesses an altered perception of male nurses, which may negatively affect the perception of the care that male nurses provide. For males entering nursing, these views

3 Men In Nursing 3 may pressure them to only work in certain types of nursing units, despite any personal beliefs or goals they may have in regards to their profession. According to The Registered Nurse Population from the Department of Health and Human Services, only 7% of all nurses were male. ( 2010) However, over 41% of all nurse anesthetists were male, reinforcing the stereotype. This literature review seeks to discover to what extent men worked in these stereotypical positions by addressing the question: where are men working in nursing today as compared to the past? In addition to merely assessing where men are working today, it became apparent that the reasons for where they work needed to be understood. As a result, gender roles and characteristics became integral to this literature review and its results. Methods In the literature review, several electronic databases were searched for articles relevant to the inquiry question. The databases utilized include CINAHL and Google Scholar. To be chosen, articles needed to be published in English and had to discuss areas where men worked in nursing in the past or currently. Articles were included regardless of date and place of publication. In CINAHL, the term male nurses yielded 1521 results. The terms men in nursing, history of men in nursing and gender-neutral roles in nursing were searched on Google Scholar. Criteria for inclusion were: discussed the history of men in nursing, discussed were male nurses work currently, discussed theories or reasons why men work in certain areas, discussed reasons for lack of men in nursing. Articles were excluded if they were found in multiple searches or were not relevant to the topic. Abstracts were reviewed to determine relevance, and studies that may be included were

4 Men In Nursing 4 read in depth. Eight articles in total that met all of the criteria were found. Faculty also provided two articles in a book and one other relevant article. Results It has become apparent that research regarding gender and gender roles is an integral part of any research into where men are working currently. The majority of the studies revealed that most male nurses work in the same areas currently as they have traditionally worked in the past. Four of the articles addressed where men have worked in nursing in the past. Two of the articles discussed where men work currently in nursing. Three articles evaluated reasons for why men work in specific areas of nursing and two specifically addressed why men are often seen in leadership roles. Three articles also discussed why men were discouraged from entering the field of nursing. Many of the articles had overlap in regards to their findings: most of them did not address only one area and are thus included in multiple groups. History of Men in Nursing Evans (2004) examined the history of male nurse in the UK, the US and Canada to show how gender has both limited and enhanced the careers of male nurses. She stated that men initially worked as nurses in militaristic religious orders, such as the Order of St John of Jerusalem, but gradually moved to other positions, such as caring for violent or mentally ill patients, mainly because men were perceived to bring increased physical strength to the bedside. Evans argues that, in the US, there was a significantly larger number of male graduates from the mental hospitals schools of nursing as compared to general schools of nursing. Hospitals chose to hire lower-paid orderlies over nurses. Men

5 Men In Nursing 5 nurses were also excluded from the US Army Nurse Corps and were not granted commissioned officer status until after Wall (2009) studied the history of the Alexian Brothers, discussing how religion and gender influenced the role they played as nurses. The Alexian Brothers initially started their nursing work in the early 14 th century when they were organized to bury those who had died of the bubonic plague. Wall acknowledged that the Alexian Brothers worked outside of the norm for that time, serving as nurses and caretakers in a time when nursing was viewed as something done only by women who were considered naturalborn healers and caretakers. The Alexian Brothers gradually came to care for others as well, including those with mental illnesses and criminals. In the 19 th century, the Alexian Brothers established their own hospitals in multiple countries to care for the sick. Because the Alexian Brothers incorporated nursing and religion, they believed they were able to enter stereotypically male areas of nursing while simultaneously providing compassion and caring to the ill. The Alexian Brothers revealed that nursing could be both a religious calling and a masculine, yet caring, profession. Mackintosh (1997) examined the role that men have had historically in England. She argued that men have indeed worked as nurses for much of nursing s history, despite the focus on female nurses. She noted that the reason for the female focus may in fact be due to the lack of research in the areas where males worked, such as asylums, military services and private nursing associations. She argued that men were often not accepted as nurses because training only existed for women and that men could only receive training through private nursing associations or through the military. Male nurses remained in the military or psychiatric institutions not only because theses areas were seen as masculine

6 Men In Nursing 6 but also because they were some of the few places in which males could receive training to be nurses. Barber (1996) sought to discover how men gradually grew less important and were less visible in nursing in Australia during the second half of the 19 th century. She stated that men still held those traditional male roles, like psychiatric nursing. Barber did note that some rural hospitals kept male nurses, or wardsmen, further increasing the confusion over the titles held by male nurses. She stated that male caregivers could be called nurses, wardsmen, house stewards, attendants, or orderlies and yet all fulfill roles that were very nearly identical to those of the female nurses. The womanly calling of nursing played the largest role in the phasing out of men from nursing, emphasizing that women were natural nurses and that men were not able to be caring. Where Men Work Currently Purnell (2007) emphasized the overall lack of male nurses worldwide, although some countries have begun actively recruiting male nurses, such as Israel. He argued that one of the main reasons for lack of male nurses throughout the world is the stereotype that all male nurses are gay. To combat the stereotype that male nurses are gay, most men work in critical care, psychiatric settings, in the military or in administrative positions, positions that are typically seen as very masculine. Men also avoid working as nurses because it has traditionally been seen as a woman s role, and with that has come an association of lower social status that men want to avoid. In one of her articles addressing the experiences of male nurses, Evans (1997) sought to discover how men s experiences impacted other nurses. Nothing again that men are often given elite specialty and administrative positions in hospitals, she suggested it

7 Men In Nursing 7 was based on their traditional male character traits. She argued that some of these traits are: men are more likely to want to advance than women; men often try to distance themselves from their colleagues; leadership positions often emphasize leadership skills and dedication to work. She also argued that men are given special treatment by others solely because there are not many male nurses. For these reasons, there are more male nurses in positions of leadership than women presently Reasons for Working in Certain Areas Evans (1997) examined why men work in certain areas of nursing. She stated that, due to traditional male character traits, men are often employed in leadership positions. In another study, Evans (1997) argued that men were more likely specialize in areas where traditional female character traits, such as the need to touch patients and the delivery of care at the bedside, are not needed. Such areas of nursing include psychiatry, anesthesiology, intensive care settings and emergency settings. Evans argues that these areas focus on multiple male character traits, such as strength, technical prowess, autonomy and cool-headedness. She also addressed the disproportionately large amount of male nurses in leadership positions when she discussed the male nurse s need to enhance their masculine character traits and downplay any female traits they may possess. Leadership Roles Porter-O Grady (2007) discussed the effect of reverse discrimination in nursing leadership. He argues that men are expected to assume leadership roles and, if they do not, then there is something wrong according to a gender-role-based idea that men are expected to possess. He argued that, while seeking advancement to leadership roles is

8 Men In Nursing 8 seen as acceptable for male nurses, their success is often attributed to the fact that they are men. These men are often seen to cause disadvantages to the women who work under them, resulting in decreased morale or like of their male manager because he is seen as taking the position away from a woman who could have performed the same duties. Men are placed in leadership positions disproportionately to the number of male nurses in general. Thus, because men often will be forced into certain roles because of their gender, they should anticipate gender issues in the workplace in order to address them. Reasons for Lack of Men in Nursing Throughout many of the articles, there was a focus on why men did not enter nursing, or why men worked only in certain areas of nursing. A common theme was the fact that this lack of male nurses is often attributed to Florence Nightingale and her nursing reforms. Nightingale s ideal nurse was compassionate and cared deeply for the patient, ideals that were attributed solely to woman at that time. Because of Nightingale, nursing became an occupation for women and excluded men for a long period of time. The curriculum of nursing schools has also been shown to be detrimental to the development of male nurses, as a number of barriers exist that limit the experience male students receive and lead to a high rate of attrition for male students. Evans (2004) argued that Nightingale s reforms completely excluded men from nursing, even preventing them from joining Royal College of Nurses in the UK. According to Barber (1996), men were basically removed from nursing in Australia by Nightingale s reforms and views of nurses as ladies to whom nursing came naturally. Hospitals would not hire male nurses because they could not possibly, at least according to Nightingale, act as a nurse should.

9 Men In Nursing 9 McMurry (2011) examined the underrepresentation of males in the nursing profession and looked at topics such as discrimination and advantages that men receive solely based on their gender. He stated that Nightingale s reforms essentially prevented males from being nurses in general for a significant amount of time. He does concede that men were able to work in the military but not many, and they were prevented from being commissioned officers. Military leaders argued that allowing male nurses to join would undermine the masculinity that is inherent in the military. McMurry reported that male nurses were in fact excluded from certain positions, such as labor and delivery nursing, or were forced into administrative positions because of their gender, despite their personal goals. McLaughlin et al. (2010) examined how the design of nursing schools relates to the overall lack of men in nursing. The authors main finding was that men were much more likely than women to not complete nursing school, for a number of reasons. One of the most important reasons is the lack of male role models for male students. As the majority of nursing school staffs consists of females, men in nursing programs often do not have someone who they can more easily relate to. Additionally, while nursing history is often taught to nursing students, education focuses mostly on Florence Nightingale and her reforms, basically ignoring the long history of men in nursing and the contributions men have made to the profession. Other factors that led to men dropping out of nursing school include difficulties with providing care to female patients and discrimination or isolation that the men felt. A key factor, according to McLaughlin et al., is the term male nurses. This term, according to these authors, should not longer be used; use of this term only results in further troubles, as it reflects the attitude that male nurses are different

10 Men In Nursing 10 than female nurses. All of these factors combined lead to a lower rate of males completing nursing school, which in turn reduces the amount of male nurses in the workforce. O Lynn (2004) studied the gender-based barriers that males encounter in nursing school and how nursing education programs have failed to attract more males to the nursing profession. O Lynn discussed how the overall lack of men and their contribution to nursing in popular nursing textbooks, the reforms of Florence Nightingale, and a lack of effort put into recruiting men to join the nursing profession has led to a dearth of male nurses. Some of the most prevalent barriers experienced by male nursing students were: lack of male role models; lack of education regarding the history of male nurses; the tendency of all nursing textbooks to use the pronoun she ; an overall lack of male faculty; and no guidance on the appropriate use of touch for males. While these barriers were most prevalent, they did not always have the most affect on a student s education. The most important and influential barriers are: a feeling of being unwelcome in the clinical setting; concern that female patients would accuse male student of acting inappropriately; a lack of support from those important to the student; lack of recruitment and presence of other men in the classroom; and limitations placed on men in certain clinical areas, specifically labor and delivery. O Lynn found these barriers to be present in a diverse sample of male nurses and concluded that nursing programs need to improve their curriculum to provide better support for and recruitment of male nursing students. Appraisal of the Literature Overall, the literature was able to effectively discuss the history of men in nursing. One of the greatest strengths of the available literature is the wide geographic

11 Men In Nursing 11 range of the articles. While the studies often addressed different regions and settings in regards to their focus, the findings were generally the same. For example, both Evans (1997) and Barber (1996) attributed the lack of male nurses to the reforms of Florence Nightingale. The largest critique of the available literature is found in the almost absolute lack of research in regards to where and why men might work in a variety of different settings. Very few articles provide substantive data about the current situation regarding male nurses. What little research that is available only reinforces the stereotypes that men choose to work in the aforementioned areas. The one true study with definitive data that was found, the Registered Nurse Population Report, stated that almost half of all nurse anesthetists were male, but that did not mention where male RN s worked either. ( 2010) While many males may indeed choose to work in these typically male areas of nursing, what about the other half of men in nursing? Might these others choose work in traditionally female areas such as pediatrics? Of all the data available, there is no mention, however brief, of male nurses who work in other areas. The literature does not even address the possibility that men may work in settings where traits such as kindness and compassion are often more evident, areas that are misconstrued as being solely in the female domain. Implications for Research The research as to where men are working currently as compared to the past is very scant. The little research available highlights the fact that men are working where they have always worked: in high-technology, fast-paced areas such as emergency rooms,

12 Men In Nursing 12 intensive care units, psychiatric units and as nurse anesthetists. However, this does not mean that all male nurses work within these areas. As demonstrated by this literature review, there is very little, if any, research that deals solely with comparing the employment of male nurses today with that of the past. Most of the research also includes reasons for why men work in certain areas and how gender traits have influenced their decisions. Further research must include gender as gender identity and traits are key to how both male and female nurses choose their positions and work effectively as registered nurses. The methods by which male nursing students are educated must also be examined. As the available literature provides a number of reasons why male nursing students only enter certain areas of nursing or even leave nursing altogether, the aspects of the current education system that affect these choices must be understood and altered. By determining the prevalence and importance of barriers that exist to male nursing students, an effort can be made to remove these barriers and improve the experiences of male students. If these barriers are better understood and more easily identified, nursing programs curriculums can be adapted to better prepare male students to be nurses and faculty can better address any issues that arise in the clinical setting. Improving the experience that male students have while in school may reduce the rate of attrition and lead to an increase in the amount men entering the nursing workforce. Allowing the public to see where men in nursing work, without including any gender expectations in the discussion, would hopefully help to breakdown any stereotypes that exist in regards to male nurses This research could help breakdown the stereotypes mentioned and reveal that men can indeed display the kindness and

13 Men In Nursing 13 compassion that Nightingale attributed only to female nurses. These studies would also hopefully allow male nursing students to realize that they are not stuck in maledominated roles, that they can indeed follow any path in nursing without having to worry about gender stereotypes and without feeling that they are not permitted to work in an area where their true passion lies. Different areas of nursing should not be seen as either male-dominated or female-dominated; rather, nursing should be seen as a gender-neutral profession where nurses, regardless of gender, can work anywhere without having to combat any bias or stereotypes. It is important to understand that all nurses, both male and female, can provide the proper care in any setting, yet do so in different ways. The term nurse should not be synonymous with female ; rather, further research should not only aim to reveal that men do indeed have a prominent role in the nursing workforce and but also remove any gender connotation associated with the term nurse and change the perception that nursing is a female profession.

14 Men In Nursing 14 References Barber, J. (1996), All the young men gone: losing men in the gentrification of Australian nursing circa Nursing Inquiry, 3: doi: /j tb00044.x Department of Health and Human Services. (2010). The registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved 2013, from Estabrooks, C. (2002). Lavinia lloyd dock: The henry street years. In E. Baer, P. D'Antonio, S. Rinker & J. Lynaugh (Eds.), Enduring issues in american nursing (pp ). New York, NY: Springer Publishing Company. Evans, J. (1997), Men in nursing: exploring the male nurse experience. Nursing Inquiry, 4: doi: /j tb00089.x Evans, J. (1997), Men in nursing: issues of gender segregation and hidden advantage. Journal of Advanced Nursing, 26: doi: /j x Evans, J. (2004), Men nurses: a historical and feminist perspective. Journal of Advanced Nursing, 47: doi: /j

15 Men In Nursing 15 Mackintosh, C. (1997), A historical study of men in nursing. Journal of Advanced Nursing, 26: doi: /j x McLaughlin, K., Muldoon, O., & Moutray, M. (2010). Gender, gender roles and completion of nursing education: A longitudinal study. Nurse Education Today, 30(4), McMurry, T. B. (2011). The image of male nurses and nursing leadership mobility. Nursing Forum, 46(1), doi: O'Lynn, C. (2004). Gender-based barriers for male students in nursing education programs: Prevalence and perceived importance. Journal of Nursing Education, 43(5), Porter-O'Grady, T. (2007). Reverse discrimination in nursing leadership: Hitting the concrete ceiling. In E. O'Lynn, & R. Tranbarger (Eds.), Men in nursing: History, challenges, and opportunities (pp ). New York, NY: Springer Publishing Company. Purnell, L. (2007). Men in nursing: An international perspective. In E. O'Lynn, & R. Tranbarger (Eds.), (pp ). New York, NY: Springer Publishing Company. Wall, B. M. (2009). Religion and gender in a men's hospital and school of nursing, Nursing Research, 58(3),